Pros and Cons of Health Care Reform BlogKeep Informed About The Pros and Cons Of Health Care Reform As It Impacts The Self-Employed and Small Business Owner.http://www.cornerstoneinsurance.info/Tue, 22 Jan 2019 00:26:39 GMThttp://backend.userland.com/rssRSS.NET: http://www.rssdotnet.com/AMERICA’S HEALTH INSURANCE (Part 3) - THE AMERICAN HEALTH CARE ACT 2017 (AHCA)- The Winners and Losers: Medicaid/Medi-Cal<p><strong>Prior to the ACA, </strong>aka Obamacare, it was difficult in most states for those without children to get Medicaid, called Medi-Cal in California.
A citizen needed at least one child and income between zero and 106% of the federal poverty level. For example, in 2013, a family of two would qualify
if they earned $16,440 and under; a family of three by making $20,702 and under; a family of four earning $24,963 and under, and so on.
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<br /><strong>Post ACA, </strong>the House-approved American Health Care Act 2017 (AHCA) would increase the income level to 133% of the federal poverty level
in most states regardless of how many children a taxpayer claims. So far, 32 states and the District of Columbia expanded Medicaid, including California,
which extended Medi-Cal’s level to 138%. This income level would increase contingent on the number of dependents. A single person making $16,643 or
less in California qualifies. A family of two, based on their tax return, would qualify if they make $22,411 and under; a family of three making $28,180
and under; a family of four at $33,948 and under, etc.</p>
<p><strong>Although we are still awaiting the Senate’s plan as of midyear 2017, the House’s AHCA</strong> phases out expansion under the ACA until the end
of 2019. Therefore, in 2020, those who already qualified would be grandfathered in and allowed to remain with their program. The bill also provides
more flexibility to the states. Instead of a per-person payment for each Medicaid recipient, they could opt for a block grant that would provide a
lump sum. Each state could then determine a set of eligibility rules, such as when a recipient would be excluded and premium costs. Under these more
flexible rules and whether they opt for the block grant, states may add a requirement that a nondisabled adult work in order to access the benefits.
Flexibility is also given to states to disenroll those who, for example, win big in a lottery or see their liquid assets loom large thanks to an inheritance.
It also allows for a hardship exemption if, for example, a recipient’s income increases but they have pre-existing medical conditions and can’t afford
their own coverage. </p><strong><span style="font-size: 11pt; font-family: calibri, sans-serif;">The winners of the House-approved AHCA?</span></strong>
<span style="font-size: 11pt; font-family: calibri, sans-serif;"> Those concerned with our national debt. The losers? Those who currently do not qualify for Medicaid but may later, perhaps. Why perhaps? Many people in
their 30s and under with income not above the thresholds mentioned in Part 2 of this blog series might prefer having private insurance with the tax
credit to being on Medicaid with its limited choice of doctors. Those with incomes teetering just above 106% of poverty level who are 50 and older,
would likely prefer our current system. I say likely because, again, they may prefer private insurance with a tax credit, even if they have to pay
a few hundred dollars a month for it. How can they afford it, you ask? I have many clients who have low income but high assets, so although they currently
qualify for Medi-Cal, they would prefer private insurance with a tax credit.</span>
<div><span style="font-size: 14.6667px; font-family: calibri, sans-serif;"><p>Part 1 of this blog series can be found <a href="file:///C:/Users/Dina/Dropbox/Business/Website/Website%20Blog/AHCA%20Part%201%20Final.docx">here.</a></p><p>Part 2 of this blog series can be found <a href="file:///C:/Users/Dina/Dropbox/Business/Website/Website%20Blog/AHCA%20Part%202%20Revision.docx">here.</a></p><br /></span>
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</div>http://www.cornerstoneinsurance.info/RSSRetrieve.aspx?ID=14536&A=Link&ObjectID=730283&ObjectType=56&O=http%253a%252f%252fwww.cornerstoneinsurance.info%252fpros-and-cons-of-health-care-reform-blog%252famerica-s-health-insurance-part-3-the-american-health-care-act-2017-ahca-the-winners-and-losers-medihttp://www.cornerstoneinsurance.info/pros-and-cons-of-health-care-reform-blog/america-s-health-insurance-part-3-the-american-health-care-act-2017-ahca-the-winners-and-losers-mediTue, 11 Jul 2017 07:00:00 GMTAHCA-The Winners and Losers-Part 2-Tax Credits and Subsidies<p style="margin: 0px 0px 13px;"><span style="font-family: calibri; font-size: 16px;">With the proposed AHCA (aka Trumpcare)&mdash;passed by the House, but not yet the Senate&mdash;you would receive an age-and income-based fixed credit, rather than a deduction, upon filing your tax return. Someone under 30 would receive $2,000 per year; between 30 and 39, $2,500; between 40 and 49, $3,000; between 50 and 59, $3,500; and 60 and above, $4,000. The sum amount of the credit cannot exceed $14,000, a maximum that comes into play for families with children. If your Modified Adjusted Gross Income (MAGI) income is $75,000 filing singly or $150,000 if married filing jointly, then the tax credit is reduced by 10% of the excess. For example, a family of four makes $200,000. Husband and wife are in their 40’s. Looking at age alone, the total tax credit is $10,000 ($3K+$3K+$2K+$2K). However, because income is $50,000 over the $150,000 limit, the credit is reduced by $5,000 ($50,000 multiplied by 10%). With AHCA, this family’s credit would be $5,000. If that family’s income increases to $250,000, they would no longer receive a credit.</span>
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<p style="margin: 0px 0px 13px;"><span style="font-family: calibri; font-size: 16px;">Those with grandfathered plans&mdash;coverage held with no changes since March 2010&mdash;do not qualify for the tax credit. That’s unfortunate, but very few clients have grandfathered plans. Another exclusion for tax credits in the AHCA is health insurance coverage of abortions. If your plan covers abortions, then you will be ineligible for the tax credit.</span>
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<p style="margin: 0px 0px 13px;"><span style="font-family: calibri; font-size: 16px;">What stays the same in both plans is disqualification from the tax credit if you are eligible for (not even enrolled in) a group health plan, a non-citizen or non-national or non-qualified alien, or incarcerated. Keeping a popular ACA provision, children up to age 26 can continue to be covered on a parent’s AHCA plan when listed on the tax return.</span>
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<p style="margin: 0px 0px 13px;"><span style="font-family: calibri; font-size: 16px;">The winners? The biggest winners are middle-income Americans: Single tax filers whose incomes are between $48,240 (our current tax credit upper threshold) and $75,000, as they would receive some relief. Also, married joint filers whose incomes are between $64,960 and $150,000 (for a family of two); $81,680 and $150,000 (family of three); $98,400 and $150,000 (family of four); $115,120 and $150,000 (family of five). The losers? Those in the lower income ranges who are older (around 40 and above) generally receive a higher tax credit currently than they would under the AHCA. This will vary greatly depending on age of the client, family size, and their income estimate. Additional losers are those who don’t have the cash flow to wait until their taxes are completed to receive the credit. <br /></span> </p>
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<a name="_GoBack"></a><span style="font-family: calibri; font-size: 16px;">Part 1 of this blog series can be found </span>
<a href="http://www.cornerstoneinsurance.info/pros-and-cons-of-health-care-reform-blog/americas-health-insurance-part1-the-american-health-care-act-of-2017-the-winners-and-losers"><span style="color: #0563c1; font-family: calibri; font-size: 16px; text-decoration: underline;">here</span>
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</p>http://www.cornerstoneinsurance.info/RSSRetrieve.aspx?ID=14536&A=Link&ObjectID=726361&ObjectType=56&O=http%253a%252f%252fwww.cornerstoneinsurance.info%252fpros-and-cons-of-health-care-reform-blog%252fahca-the-winners-and-losers-part-2-tax-credits-and-subsidieshttp://www.cornerstoneinsurance.info/pros-and-cons-of-health-care-reform-blog/ahca-the-winners-and-losers-part-2-tax-credits-and-subsidiesSat, 10 Jun 2017 07:00:00 GMTAmerica's Health Insurance-Part 1-The American Health Care Act of 2017-The Winners and Losers<p>The AHCA (aka Trumpcare) has passed the U.S. House of Representatives and is, understandably so, a hot topic. Being an insurance broker for nearly 30 years, I&rsquo;d like to share my opinions on this matter that&rsquo;s so vitally important to us all. This blog post is Part 1 in a series that will address the issues. <br />
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First, let me set the stage of my overall view on health care reform. I found our pre-ACA (aka Obamacare) system in severe need of repair. Although it produced winners and losers over our pre-ACA system, the ACA was drastically different than my idea for reform. Similarly, the AHCA is also a radical departure from my reform preferences, although it too will produce winners and losers over our current ACA system. But alas, no one in a position of power asked for my opinion. <br />
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Let&rsquo;s start dissecting the AHCA. The winner of the ACA system over the pre-ACA system <em>seems to be</em> those with pre-existing conditions. Is this actually true? Possibly. First, it depends on the state where you live. Here in California, we had a major risk pool for the uninsured (MRMIP), as did many other states. It was subsidized by the state to help keep costs as low as possible. Let&rsquo;s compare rates. In 2013, a Kaiser MRMIP plan for someone living in Sacramento County cost approximately $452 for a 40-year-old, $573 for a 50-year-old, and $727 for a 60-year-old. This was for a plan that offered low copays, no deductible and a $2,500 maximum out-of-pocket. However, it did have a $750,000 lifetime maximum. For similar coverage through Anthem Blue Cross in a PPO plan, the premium was about $670 for a 40-year-old, $822 for a 50-year-old and $1,246 for a 60-year-old. Now, let&rsquo;s compare today&rsquo;s premiums for the similar Platinum Plan ($0 deductible, but $4,000 max out of pocket). Kaiser/Anthem is $514/$708 for a 40-year-old, $718/$989 for a 50-year-old, and&nbsp; $1,091/$1,504 for a 60-year-old. Looks eerily similar. But remember, we&rsquo;re comparing rates for those who were declined medical coverage, so they had to go with the MRMIP plan.<br />
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Now, let&rsquo;s compare premiums for those who passed their medical screenings. In 2013, Kaiser would have charged a healthy 40-year-old $451 for similar coverage; $508 for a 50-year-old and $646 for a 60-year-old. Anthem&rsquo;s rates were a comparable percentage decrease. If we only consider those who couldn&rsquo;t get coverage previously, who are the winners? You could argue no one wins on that issue alone. However, once we mix in the Advanced Premium Tax Credits and subsidies, we will see more winners. You may be surprised that the biggest losers are people who pass their health screenings. For those who were unable to get coverage in California and who are above 400% of the federal poverty level, it was practically a wash. &nbsp;</p>
<p><strong>How does the AHCA differ? </strong>If you apply during open enrollment or other times of the year, but you have a qualifying event such as loss of group coverage or getting married, you continue to have access to coverage without paying extra. However, AHCA added a &ldquo;not continuously covered&rdquo; penalty. This means that if you go more than 63 days without coverage, you pay a 30% up-charge for that plan year only. If signed into law, this would begin in 2019. <br />
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Now, before you worry about the 30% up-charge, let&rsquo;s look at what is removed. The AHCA eliminates the individual and business mandate that requires all individuals to have coverage (with a few exceptions) or pay a tax. If approved in its present form, the retroactive effective date of that tax removal is &ldquo;months beginning after December 31, 2015.&rdquo; Will a finalized copy adjust this to a more current date? Likely. If not, does this mean that those who already paid the tax for the 2016 tax year will be reimbursed? That remains to be seen, so stay tuned.</p>
<p>Who are the winners in regard to coverage for those with pre-existing conditions? People with pre-existing conditions who stay covered will see no change except potentially lower premiums&mdash;<em>if</em> this penalty results in more people staying covered. However, I doubt this penalty is steep enough to strong-arm a significant number of those who prefer to or, due to economics, need to remain uninsured. The 30% --charge applies to individual coverage only and not to group plans. </p>
<p>At this point, I expect some of you are about to pounce and ask about the AHCA loophole, aka the MacArthur waivers that states may apply. One waiver is that in lieu of the 30% up-charge, a state may instead require that individuals with more than a break in coverage of 62 days go through medical underwriting and be potentially charged a higher rate than those without pre-existing conditions. Again, this is only for those with more than a 62-day break in coverage. Based on an individual&rsquo;s answers about health history, medical underwriting analyzes what percentage of up-charge is warranted. Only states with programs to provide financial assistance to high-risk individuals and states that participate in the federal program that helps offset the risk can apply for the waiver. Approximately $8 billion would be set aside to help those states fund a risk-share program to help reduce the premiums for those high-risk individuals. </p>
<p>However, the gender rating protection cannot be waived, so males and females will continue to pay the same premium. If a state decides to implement this waiver, some who go more than 62 days without coverage might find themselves paying more than they would under our present ACA system. Is that wrong? I think this system is a good balance. Prior to the ACA, we went too far in one direction making it difficult for those with even the slightest pre-existing condition to get covered. For example, a client was declined coverage for having high blood pressure and high cholesterol. The ACA went too far the other direction and made it much too easy to go without coverage, get sick and then get covered all the while paying the same as someone who stayed continuously covered and perhaps rarely used their plan. Now, those who purposefully decide to be uninsured <em>until</em> they need services contribute to higher increases in premiums that all have to pay. To be sure, there will be some who, due to no fault of their own, find themselves without coverage, which would be a shame. Fact is, I do not know how to avoid the latter without allowing those who are tempted to game the system with greater ability to do so. There will still be protections for those who honestly cannot afford it, which I will address in a future blog.</p>
<p>Please don&rsquo;t get me wrong. I <em>love</em> guarantee issue coverage in which one is not declined for their pre-existing conditions. I&rsquo;m glad it is sticking around so I no longer have to ask my clients intrusive medical questions. I also appreciate that those who lacked insurance due to no fault of their own would have easy access to coverage without MRMIP&rsquo;s typical six-months waiting period. In addition, both the ACA and the AHCA eliminated the much-too-low $750,000 lifetime limit on the MRMIP plans. An extremely long hospital stay in California, for example, would surpass that lifetime maximum in about two weeks. I do, however, wish that health care reform would provide discounts to people who engage in wholesome habits, so even someone with a severe medical condition could qualify for savings. But again, no one in a position of power asked for my opinion. Stay tuned for the next issue that will discuss the change in the tax credits helping citizens afford the coverage.&nbsp;</p>
<p>Part 2 of this blog series can be found <a href="http://www.cornerstoneinsurance.info/pros-and-cons-of-health-care-reform-blog/ahca-the-winners-and-losers-part-2-tax-credits-and-subsidies">here</a>.</p>http://www.cornerstoneinsurance.info/RSSRetrieve.aspx?ID=14536&A=Link&ObjectID=723468&ObjectType=56&O=http%253a%252f%252fwww.cornerstoneinsurance.info%252fpros-and-cons-of-health-care-reform-blog%252famericas-health-insurance-part1-the-american-health-care-act-of-2017-the-winners-and-losershttp://www.cornerstoneinsurance.info/pros-and-cons-of-health-care-reform-blog/americas-health-insurance-part1-the-american-health-care-act-of-2017-the-winners-and-losersMon, 22 May 2017 07:00:00 GMTWas Health Insurance Reform Needed?<p>Did our health care system need reform? Yes, but the real reforms needed to be done at the medical systems arena. When we remodel our bathroom, we get 3 bids. Do we do this same comparison shopping when facing an expensive medical procedure? For most of us, no. Even if we wanted to, we wouldn&rsquo;t be able. Medical systems and insurance companies are tight lipped about what rates will be charged for various services with various insurance companies. This secrecracy in part is to help add future negotiations between hospital and medical groups and the insurance plans. In the glory days, no one much cared what the prices were.&nbsp; The doctors and hospitals charged the rates and no one much complained except once a contract was up and the powers at be once again sat down at the negotiating table. Now that consumers have more teeth in the game with higher deductibles and copays, they are desiring to do more shopping. Also, the government has put the squeeze on insurance companies so they need to be the bad guy and put the squeeze on hospitals and medical groups.&nbsp; This &ldquo;squeeze&rdquo; needed to happen but before it had real impact we threw guarantee issue coverage in the mix. If premiums are unaffordable, the healthy people, especially those without many assets, will go uninsured and only the unhealthy will sacrifice to have the insurance. This will in turn compound the issue. </p>
<p>As a broker, I am asked often, will the Affordable Care Act aka Obamacare help or hurt me? My answer, it could easily go either way.&nbsp; Will the uninsured sign up in droves like some think will happen now that health insurance is mandatory or you pay a tax? The ones eligible for a tax credit, likely. The ones with dramatically higher incomes? Most of them were insured already and they likely have more asset they would risk losing without insurance, so yes, probably. Those in the middle? I think we will see more of these people go uninsured then currently.&nbsp; My end conclusion, it&rsquo;ll be a net wash at least initially until cost of care can be tackled. Will it be tackled? Will there be enough legislators willing to go after the powerful American Medical Association? I will wait to see with anticipation.</p>
http://www.cornerstoneinsurance.info/RSSRetrieve.aspx?ID=14536&A=Link&ObjectID=390501&ObjectType=56&O=http%253a%252f%252fwww.cornerstoneinsurance.info%252fpros-and-cons-of-health-care-reform-blog%252fwas-health-insurance-reform-neededhttp://www.cornerstoneinsurance.info/pros-and-cons-of-health-care-reform-blog/was-health-insurance-reform-neededMon, 19 Aug 2013 19:44:00 GMTPre-existing Conditions and Health Insurance Reform<p>Over the years, I had the great displeasure of having to inform clients that their health insurance application was denied. Their only option at that point
was to apply for coverage through the Major Risk Medical Insurance Bureau which was super expensive for limited coverage. In 2014, coverage will be
guarantee issue for everyone. Not only will it be guarantee issue, the premiums will be the same for those with pre-exisitng conditions as it is for
those without. This means there will be no need for insurance companies to have medical questions on their applications. This is a huge sigh of relief
for many people. Even if you don’t have pre-exisitng conditions, you will benefit by not having to answer pages of medical questions during the application
completing process. Just the other day, a client came in and decided on a health plan for her and her family. She decided to apply online right there
in my office. About two hours later, that application was complete. Now granted we ran into a few technology hiccups but still, that is a long time
to complete an application. She and her family were very healthy, it would have taken even longer for those with a lot of pre-exisiting conditions.
How will the rates vary? By your age but only with a 3 to 1 rating and based on the county you live in.</p>
<p>What does a 3 to 1 age rating ratio mean? Currently, we have a 6 to 1 age rating ratio which means if someone in their 20’s was being charged $100 for
a plan, someone in their 60’s couldn’t be charged more then $600 for that same plan. Starting next year, someone in their 60’s can’t be charged more
then 3 times what someone in their 20’s is being charged. This will bring up the premiums for those in their 20’s and 30’s and lower those in their
50’s and 60’s. Not necessarily lower then what they are today but lower then what they otherwise could be in 2014 and beyond. Your rates will also
vary based on the county you live in. The southern, more populated counties will be lower then the northern less populated counties due to the ability
for lower provider cost in the more populated counties that have more provider competition.</p>
<p>The Affordability Care Act allows for insurers to offer a higher rate to those that smoke then those who do not but California decided to NOT allowed California
insurance carriers this rating ability so in CA, rates will be the same for smokers as they are for non-smokers.</p>
<p>No matter how you feel about the sensibility of the Affordable Care Act, you must admit, the simplicity of getting a rate quote and the application process
will be a great benefit.</p>http://www.cornerstoneinsurance.info/RSSRetrieve.aspx?ID=14536&A=Link&ObjectID=383620&ObjectType=56&O=http%253a%252f%252fwww.cornerstoneinsurance.info%252fpros-and-cons-of-health-care-reform-blog%252fpre-existing-conditions-and-health-insurance-reformhttp://www.cornerstoneinsurance.info/pros-and-cons-of-health-care-reform-blog/pre-existing-conditions-and-health-insurance-reformThu, 18 Jul 2013 07:00:00 GMTCovered CA participating insurance companies announced<p>Covered CA announced in May the insurance companies participating in the individual exchange, called Covered CA. In the greater Sacramento area those four
companies will be Blue Shield, Anthem Blue Cross, Kaiser and Western Health Advantage. Health Net is offered in other counties. Health Net is participating
in certain counties but not Sacramento. Aetna has decided to no longer offer individual coverage in CA for new subscribers and January 2014 for current.
Cigna and UnitedHealthcare have chosen not to participate at least initially. Will they prove wise or foolish? The media and government spokespersons
are jubilant that the individual rates aren’t as high as some were predicting. Yes, that is good news and we can take a slight breath but the rates
are still increasing by up to 25% (depending on age and county and health status). These are the numbers Covered CA released. How did they arrive at
the numbers? Are they a fair representation? We won’t know until we can begin quoting October 1st.</p>
<p>For those qualifying for the Advanced Premium Tax Credits (APTC’s) and subsidies, yes, rates will look very good compared to now. Those who’s incomes are
within 138% and 250% ($15,856 to $28,725 of income if family size is one) of federal poverty level will qualify for tax credits to help offset the
premiums AND subsidies to help offset some of the copays an deductibles. Those whose incomes are within 250%-400% ($28,725 to $45,960 of income if
family size is one) of federal poverty level will qualify for tax credits to help offset the premium but not the subsidies. For those who are currently
uninsurable or get approved with really high rates, yes probably more affordable. For those above 400% of federal poverty level and healthy and young,
definitely not more affordable.</p>http://www.cornerstoneinsurance.info/RSSRetrieve.aspx?ID=14536&A=Link&ObjectID=383621&ObjectType=56&O=http%253a%252f%252fwww.cornerstoneinsurance.info%252fpros-and-cons-of-health-care-reform-blog%252fcovered-ca-participating-insurance-companies-announcedhttp://www.cornerstoneinsurance.info/pros-and-cons-of-health-care-reform-blog/covered-ca-participating-insurance-companies-announcedThu, 18 Jul 2013 07:00:00 GMT